If Tomorrow Never Comes
by Meredith McGarrett
Summary: AU Meredith. Meredith's life mostly consisted of open heart surgeries, cardiac catherizations and doctor's appointments but she also experienced love and happiness and real friendship throughout the years. She never let her medical condition stop her from having the life she wants ... Prequel to 'Nothing Turns Out The Way Its Supposed To' [MerEllis / MerCris centric]
1. Chapter 1

**Chapter 1 "The Beginning Is Always The Hardest Part"  
**

* * *

 **This is how my mother wanted to be remembered. My memory of her is a little bit different. I'm sure everyone remembers their own version of her. Versions I wouldn't even recognize. It's all that's really left of someone when they're gone. But that's the tricky thing. Nobody's memory is perfect or complete. We jumble things up. We lose track of time. We are in one place and another. And it all feels like one long, inescapable moment. It's just like my mother used to say: The carousel never stops turning. They say we can repress our memories. I wonder if we're just keeping them safe somewhere. Because no matter how painful they are, they are our most valuable possessions. Our lives are built on our mistakes as much as our successes. They made us who we are.** Meredith Grey and Ellis Grey; Only Mama Knows

* * *

"Grey, you go home." Her superior called her name. Ellis looked up in surprise as Dr. Jensen told her to go home. "You're done for this day." "But ..." Ellis started to protest almost immediately. "Don't even get me started, Grey. You do exactly as I say. You should have stayed home weeks ago." Her superior was annoyed at her. Ellis Grey rolled her eyes but didn't reply. Except: "Yes, sir." "Glad you can follow orders ..." He replied ironically. Her fellow residents were looking at her condescending and patronizing. As if she wasn't fit to do her job. But they were wrong. Ellis Grey didn't know what to reply. Why are they thinking about sending her home? Ok, she was due in almost three weeks and any other woman would have stopped working a long time ago. But this was Ellis we're talking about.

She was going going to work until she couldn't anymore.

But right now, she was so tired. Her baby had been kicking her a lot.

Normally, she would have liked it but when it was interfering with her being able to work, she didn't know if it was that good. Today, she was forced to leave the operating room room due to the fact that she hasn't been able to concentrate with her baby using her bladder as a punching ball.

She sighed as she switched from her scrubs into normal street clothes. "Ellis?"

When she heard a man's voice, she looked up only to see Richard Webber standing there. "You're going home?" He asked, his brows her knitting in concern. Ellis huffed, she still thought that they're being ridiculous with sending her home. If she was going to have a medical emergency concerning her baby she'd be much safer in the hospital than at home.

Of course she'd done her research.

Placenta previa.

... and all other kinds of scary things that might neccessitate a Cesearian section. Ellis knew the odds.

Even though she was general surgeon or at least going to be a general surgeon. She was good, she had the talent and she was a woman. She was someone of her generation. She was going to be great.

She knew it.

But right now she was just tired and wanted nothing more than to lay down in an on-call room. But instead she had to go home.

"Ellis?" The voice repeated. "Yeah?"

She turned around, only to see Richard standing there, a creepy smile on his face. "What are you doing here?" Ellis asked. "Not that I'm not happy to see you but why are you here? Isn't Grahams letting you scrub in on his surgery? What are you doing here, passing up that amazing opportunity?"

"I just ... wanted to see how you're doing." He stammered. "I'm pregnant, not sick. There is a difference." Ellis answered annoyed. "I know, I just ..." "Well, I'm sick of people babying me." She complained as she was standing there shirtless not caring if Webber saw her like that. "You're almost three weeks away from your due date. You've gotta take it easy." He cared about her. But he also loved Adele. But he also had feelings for Ellis. God, love really was complicated.

 _God, why is this so tiring and exhausting?_

Surgery was the one thing Ellis really lived for. And for the tiny human she was currently growing. She groaned suppressed. She'd wanted to stay at the hospital but the Chief insisted that she was going on. Her feet were aching and she had been suffering from Braxton Hicks all day. She even considered going to OB to get checked out. Ellis Grey was very tired. The doctor had recommended that she should do shorter hours at work and maybe he was right and she should really listen to him. After all, this was her child they were talking about.

Richard was hovering.

Although she did shorter hours than a normal resident. Then again, she was a woman and she was pregnant.

When Richard was paged she got into her car and drove back to her home.

In the night, she awakened when a sharp pain ripped through her abdomen. Her first thought was _damn it, it's too early for her to come. Now is not the time._ But when she started timing her contractions she counted that they were coming every fifteen minutes. Maybe it'd be safer to go to a hospital than to stay. Who knows what could happen?

No one.

Absolutely no one.

"Yes, hospital." She mumbled quietly as she grabbed her old phone and with shaky fingers, she called 911. She knew she wouldn't be able to drive a car and didn't want to get into an accident. After some minutes, minutes that seemed like an eternity, the ambulance was there. "Finally." Ellis mumbled as they were on their way to the hospital. She had no idea what would happen in the next few that but it wasn't good.

* * *

"Dr. Grey." The nurse, Lydia, greeted her. "The doctor will be shortly with you." Ellis never replied anything coherent. She looked up when Dr. Mahiss entered the exam room. The ultrasound machine was already there, on stand-by. She wasn't giving birth today and especially not at Seattle Grace. She was now at Seattle Presbyterian. She'd told the EMTs to bring her there and not to Seattle Grace. "Let's see what we've got. So, you're in labor?" She asked. Ellis grimaced before replying: "Yeah, pretty sure I am." Right on schedule, another wave ripped through her and she groaned loudly.

"Where's the father of the baby?"

"He left us."

She was now talking about the fetus and herself. "Ok." She knew the doctor was judging but she was too exhausted to care. "Let's just take a peek, ok? You've done the prenatal testing for genetic diseases like Down's or DiGeorge?" Ellis nodded in reply, as the doctor turned on the ultrasound machine and reached for the transducer.

"Of course." She hasn't taken any chances and for now, her pregnancy had been without any mentionable events that have happened. That's when the baby showed up on the screen of the monitor.

Ellis was once again fascinated.

"Hey, little one." She whispered as she looked at the monitor screen. She was looking at her baby girl.

That didn't happen often but in cases like this ... she could get emotional.

They tried to stop it but it wouldn't work. So it seems like Ellis was giving birth today. And not in three weeks as in anticipated. "Ok, I want to monitor your labor so I'm going to do this." As she explained Ellis didn't really listen. She couldn't have the baby now, could she?

"Dr. Grey are you listening?" The doctor asked.

"Uhm, what?"

"I'll take that as a no. We will use external monitoring to monitor the fetal heartbeat and the progression of the labor." Ellis nodded as they wrapped a pair of belts around her abdomen. One belt uses Doppler to detect the fetal heart rate. The other belt measures the length of contractions and the time between them. Ellis knew that.

She also knew that she had to stay in bed. But she could move and find a comfortable position.

 _ **Hours later:**_

The labor was progressing very slowly. It was exhaustive. Richard was with her, when he had the time in between doing doctor things. He'd taken some time off when he heard that she was about to give birth. Ellis was glad for him being there, especially since Thatcher had left after she told him. He'd said that she was married to her work and that he didn't want to live like that. Always wondering when she would be home from surgery. And so he left. Ellis had never heard anything from him and honestly she didn't care.

He wasn't there when she went to her OB to find out her baby's gender. He wasn't there.

She was alone and scared. He'd left her.

Ellis didn't want to think about and just as that, another contraction was coming. She grunted in pain and gripped Richard's hand tightly. But then he was called away. "I'm sorry but they're paging me. I've gotta go." "Don't you dare leaving ..." She screeched, breathing heavily. In and out an in and out. "You're doing great." Her OB told her to interrupt her. "Yeah? Doesn't really feel that way." She mumbled as another contraction was ripping her apart. The contraction were coming closer apart. Now they were coming every few minutes. "Ok, now push." And Ellis did. It was hard and painful but she did it. Although he had no idea how she did it.

When she was finally crowning, she was relieved. Her OB told her: "Don't push, the baby's head is crowning. Just give it a second." Oh, damn it. She wanted Richard, she fell back against the cushions and closed her eyes.

"Now, push." She advised her.

"Can't." It was just too painful. "I can't." She breathed. "It's too much. I want a c-section."

"You can do this, Dr. Grey. Just give me one last push."

In that moment, the fetal heart monitor was giving an alarm. "Damn it. Grey, your daughter's heartbeat has slowed down considerately. You have to push."

She grunted.

"Are you breathing? You have to breathe." The doctor said alarmed. "Don't tell me when to breathe. I breathe when I want to breathe." Ellis stared at him icily.

 _Come on, Ellis, do it. For your little, innocent girl who is your daughter._

And finally she started listening to what her doctor said. "I want you to push when the next contraction comes." Ellis felt beads of sweat forming on her forehead and she was exhausted. She wanted to sleep. She was thirsty even though she got fluids intravenously. She had no idea if she could do it again. But then, finally her daughter was out. She was tired, achy and she couldn't do anything. She couldn't push anymore ... then she remembered that her daughter was already born.

But there was no cry ... Immediately, commotion set off.

* * *

Meredith was born at a very sunny day which was a rarity in Seattle.

* * *

"Is she healthy?" Ellis asked, panic creeping up in her. "Why isn't she crying?"

"She's premature, Dr. Grey. She'll have to spend some time in the neonatal intensive care unit."

The pediatrician was handling the small baby very cautiously, he checked heartbeat and breath sounds as well as bowel movement. He examed the anus to check for anal atresia.

The A.P.G.A.R. score is used as a part of early assessment of a newborn in the 1 and 5 minutes after birth. The maximum score that can be assigned is 10. Scores ranging from 7-10 are considered normal. They were testing the baby's heart rate, respirations, skin color / oxygenation, reflex irritability to tactile stimulation and muscle tone and movement. But apparently something was wrong. Her baby wasn't adapting properly. She hadn't head Meredith scream or cry. The doctors worked on her, trying to get her to breathe. Someone had gotten her onto a monitor and was bagging her.

Ellis was scared but nobody was talking to her or telling her what was going on with her baby girl. She thought maybe it would be good to start praying for a miracle even though she wasn't even religious. But at that moment, she wanted nothing more than for her baby to live. "How is she doing?" Ellis asked scared.

"Let's prep her for transport to the neonatal ICU." Voices were talking quietly about her A.P.G.A.R. score.

Ellis figured that it was a low score. Both scores had been low.

And now appropriate measures were taken to make sure her baby was ok or at least going to be okay. Her thoughts raced. Why the heck was this happening? Yesterday, she'd been assisting in a surgery and now she was hospitalized and had just given birth to a preemie with a potential life-threatening condition. Why weren't they answering? This wasn't good.

It just couldn't mean anything and Ellis knew that.

"Pulse is below 100 beats/min, that makes 1 point." Ellis' heart felt like someone was ripping it out screaming, "screw you, Ellis" and then laughing. She wasn't regularly breathing and there was no strong cry. Her respirations weren't good either. It was somewhere between irregular, weak, slow and absent for some part, her skin color was between blue at extremities; pink body and cyanotic. There was some flexion. As for her refelex irritability to tactile stimulation - first, there was silence; no response to stimulation but then after some minutes, the little baby finally responded with a grimace and a feeble cry.

"What's her A.P.G.A.R. score?"

"Well, it's ..."

"Name me an exact number." The doctor said as she talked quietly with the pediatrician. Ellis had a bad, a very bad feeling about this.

Something was horribly wrong and she knew it.

"We'll have to do a more thorough exam in the NICU." Then they took her little girl away without letting her hold her for a second. Ellis closed her eyes in horror. She hadn't imagined that, it to be like this.

 **Two Hours later**

When Ellis held her little girl for the first time she forgot all her worries. She forgot about surgery and how she missed out on amazing surgeries while being on maternity leave. She focused on her amazing, perfect, stunning, little girl. She was so sweet and she was the most beautiful baby in the entire NICU, although there were so many catheters, intravenous lines and the ECG electrodes that were monitoring her baby's heart rhythm. Meredith moved her a bit, kicking against Ellis' arms softly as she picked her up. She knew she should have waited for neonatal nurse to come here and supervise but she was a doctor, she knew how to handle babies. Ellis was happy, relaxed but tired after going through hours of intense labor.

They call it labor for a reason and now she knew why. But in the end it had been worth it. She knew that when looking at her daughter. A tiny, a little underweight baby who was very quiet. She wasn't screaming or crying. She was quiet. But she was looking at Ellis with childlike curiosity.

She saw her tiny face, her tiny feet and hands. Her blue eyes that had a shade of grey - she was beautiful.

"Meredith Grey."

That was the baby's name.

She was beautiful and despite her beauty and awesomeness, Ellis couldn't help but feel like something was wrong with her baby girl. She was cyanotic, her lips were blue but the doctors said it was due to her patent ductus arteriosus.

But Ellis knew it had been something more serious. Call it mother's instinct but nobody listened to her. They just a frightened mother and not a surgeon who knew about those things. But turned out her hunch was correct. There was indeed something wrong with her baby girl. She cradled her baby in her arm and was looking at her, for once enjoying this moment. "It's just you and me, baby girl. It's just you and me." She repeated.

"But we Grey girls do fine on our own, don't we?" Ellis cooed at her.

Meredith made a noise that sound like a giggle.

She smiled.

And for once in a very long time, she felt happiness creeping up in her. She didn't know that that happiness wouldn't last long.

But then her lips went cyanotic again and she seemed to be having a little trouble with breathing properly. She was breathing fastly and shallowly. Ellis grew worried. She was showing a lot of cardiac symptoms lately.

Maybe they should do a pulse ox to rule out possible CCHDs.

"I love you." Then she kissed her on her forehead and rocked her to sleep. Ellis watched the sleeping girl in her arms when a nurse knocked on her door and came in. "Hey, I'm just checking in." Ellis looked up concerned. "She's been getting getting cyanotic. I think you should do an ECHO. I'm a doctor I know the differential diagnosises. It could be something much more serious." Ellis was getting ready to fight for Meredith.

She is Meredith's advocate and parent, after all. The parent she has left.

"Mrs. Grey. I'm sure ..."

"How sure?" Ellis cut her off bluntly. "How sure are you that there is nothing wrong with her?"

"I ... I'm paging the pediatrician to look her over." The nurse said hastily.

 **A week later**

It had now been a week since Meredith Grey was born.

At first, everything looked good so far. Her APGAR score had been a bit low, but besides that, everything looked as it should be. The doctors blamed her being born three weeks premature as the cause for the low APGAR score. Nobody ordered any tests to go any further. The doctors were sure Mer had been born healthy which turned out to be huge, undeniable mistake that almost cost her life. Because after three days her patent ductus arteriosus, full name is PDA, the fetal connection between aorta and pulmonary artery, closed, that resulted in her declining rapidly.

Her BE score was -7. BE was short for _base excess_.

Meredith suffered from metabolic acidosis that needed to be corrected. "We need to reopen her patent ductus to re-establish blood flow to the body. Her body cannot sustain this much longer."

They were starting to treat her for shock. She already was intubated and a vent was breathing for her so that they could control it. They did it because there were signs of pulmonary edema.

Their goal was it to get her oxygen saturation up to 95%. But that seemed to be difficult.

Ellis looked at the heart monitor.

Hoping that somehow everything would turn out alright.

She showed serious symptoms off cardiac distress and went into circulatory collapse because her aorta was interrupted, meaning her body wasn't getting enough oxygen, because the connection between the pulmonary artery and aorta was missing. Meredith showed early signs of heart failure due to pulmonary flooding.

It put additional strain on her heart.

After a while she was getting cyanotic, but it wasn't that clear because of the pulmonary recirculation. They thought it was due to the _patent ductus arteriosus_. But they were wrong. And the fact that they were wrong almost killed Meredith.

Her condition deteriorated fast. Too fast for anyone's liking.

"Why the hell is this happening?" Ellis screeched as they were working to get Meredith stable.

The monitor set off an alarm.

It was beeping.

The numbers and values were bad, indicating that there was something severely wrong with her daughter.

 _She cannot die, not yet. You can't go yet, Meredith._

 _Mommy won't allow it._

She thought as she was watching the pediatrician page Cardio.

"Page _Cardio_. Make it fast."

Someone screeched hasty orders and they all followed them quickly. Ellis didn't leave Meredith's side for a second. What if she left her just for a moment and her heart would just stop to beat? She'd never forgive herself if she wasn't there when it happened. "Nurse!" The doctor called as he was ordering an emergency echocardiography. Damn it, he thought. How could they have missed this? This is potentially life-threatening.

"You said she's healthy. She is _not_ healthy. She is cyanotic."

The doctor was now giving her furosemidto treat her pulmonary edema and something for preload and afterload reduction. "Why was I paged?" The on-call attending interrupted loudly. "She's getting instable." One of the doctors called out.

"Do something to stabilize her."

No one looked up. They were all focused on Meredith.

"Don't stand there and just watch her die. Do something, stabilize her." Ellis told them, her voice breaking.

"Dr. Grey ... we're doing everything we can. But you need to go to the waiting room. We'll update you as soon as we get the chance-" His response was cut off by the cardiac monitor that started going off. Ellis diverted her glance the monitor and saw how Meredith's state was deteriorating before her very eyes.

This couldn't be happening. It just couldn't be ...

But it was.

But first, the physicians really did not respond. But then the doctors, in particular Ellis Grey noticed that she suffered from tachypnea, and besides, she´s had hepatomegaly, Meredith was lethargic and had poor feeding. And when they noticed there were blood pressure differences between her lower extremities and the upper body, the doctors thought for the first time of a congenital heart defect. As soon as they're had her stabilized, they rushed her into surgery.

"I'm sorry but we're ... we think there could be something wrong with her heart." The treating physician said.

"How could you have missed this?" Ellis asked, trying to be strong.

* * *

How can it be that they just missed it when assessing her using the A.P.G.A.R. score?

Why was it Meredith who has that kind of defect? Why was it her daughter who was born with that defect?

40 000 children are born with congenital heart disease annually, a lot of them live into adulthood - but still why her daughter? Why had Meredith been born with such a medical condition that will affect her troughout her life?

Her entire life ...

* * *

Because Meredith showed the symptoms of a severe coarctation of the aorta, the leading physician scheduled an echocardiogram. And it revealed something very shocking. "Okay, it's ... oh crap. " The ultrasound technian stopped at the heart of her daughter. He enlarged and reduced image and stared at the screen. Ellis was getting nervous. "What is it?" Ellis broke the tense silence. Only the clicking of the monitor could be heard. "There is, unfortunately, the suspicion that your daughter has a serious heart defect." The gynecologist told Ellis.

"A heart defect?" Ellis asked, shocked.

The general surgeon had to digest that fact for now. She'd been thinking this but that it actually happened is something else.

 _A heart defect?! That could be anything._

It can be small holes in the septum to highly complex malformations of cardiac chambers and the surrounding vessels. Heart defects were the most common congenital abnormalities in infants. "I'm about to page someone from cardiology and then ..." The doctor said: "It will be all right. The diagnosis of CHD does not mean that your baby dies. Today, there are ways and means to save the lives of these babies. Even highly complex heart defects can be treated well today. Listen, it's not hopeless."

Ellis scoffed.

"I know that. But even if you manage to save her, there's is still the possibitly of her needing another surgery."

Her voice quivered as she glanced onto the monitor.

The expresses the slimy gel on the transducer and started. First four-chamber view, then five-chamber view and then the heart valves ... They also looked on the monitor, clicked again and again to other views. But what had been discovered while performing the ultrasound was terrifying: Double Outlet Right Ventricle with TGA type and on top of that an interrupted aortic arch type A, where was an interruption of the aortic arch distal to the left.

"Oh, shit." She said softly.

"That can not be true ..." Ellis thought only after looking at the monitor. The pediatrician and pediatric heart surgeon were studying the images and talked for a while. Ellis was getting increasingly nervous.

 _What persuaded them for so long?_

 _That could only mean that it was really a heart defect._

 _There are very many dangerous, sometimes life-threatening heart defects._

Double Inlet Left Ventricle Double outlet right ventricle, pulmonary atresia with ventricular septal defect, Left Ventricle Outflow Tract Obstruction, Hypoplastic left heart syndrome, Interrupted aortic arch, transposition of the great vessels, tetralogy of Fallot, unbalanced atrioventricular septal defect ... there were so many ugly possibilities. _  
_

Ellis gripped onto her little girl's hand. She was squirming, wanting them to stop pressing that uncomfortable, ugly thing at her chest. She whimpered. But they didn't show any emotions. But it was hard to watch for Ellis, like really hard.

Then the pediatrician turned to Ellis, a serious face expression.

"Er ... Dr. Grey, the ECHO revealed that Meredith is suffering from a complex congenital heart defect."

Ellis swallowed harshly. She couldn't believe it.

This was it.

Her daughter was going to die.

"She was born with something that looks like double outlet right ventricle with pulmonic stenosis and associated interrupted aortic arch." The pediatrician said. "That combination is causing her saturation to fall. It's also what's causing the cyanosis."

"Ok."

She stammered a bit as she said that.

Ellis Grey was overwhelmed by what she was just told. It seemed unbelievable. But then she arranged a transfer to Seattle Children's Hospital Heart Center to let them treat their daughter's heart condition. They tried to tell her that Meredith wasn't stable enough but they had already messed up enough.

Now she was riding in the back of an ambulance. A pediatrician was constantly monitoring Meredith's vitals in case she decided to crash again. But then they finally arrived, a competent group of doctors was waiting for them, Ellis was glad.

Now finally, her daughter was in good hands.

She watched them rush her inside, putting her on meds. Securing an OR for an emergent procedure and putting her on the OR board. Ellis let go for a moment, she was crying silently. Normally, she wasn't this emotional over something like this. But this wasn't a normal situation.

This was life and death - or touch and go - at the brink of death ... is what this was.

Her daughter was a patient.

A pediatric heart patient who will need specialized care for the rest of her life.

That she was born with a critical heart condition. She needed surgery. _Needs_ surgery.

If she doesn't have the surgery, she could die.

She could die right now in this moment.

For a moment, she felt like she couldn't breathe. But then: "We need your signature to rush her into surgery." The pediatric cardiologist said as he looked at her empathetically. "We're so sorry." Sorry doesn't begin to describe her feelings, the grief, the pain, the unknown of what would be tomorrow ...

Maybe Meredith would be gone by then. Maybe she'd be dead - but maybe she keeps fighting and has a real shot at a life with quality of life. Ellis wanted her to have that shot. So she signed the papers that said she was agreeing to the surgery.

That was a shock for Ellis Grey, Thatcher had been gone by then and now she was all alone ...

However, it had missed out in the echocardiography that Meredith had been born with a complete atrioventricular septal defect, which is primarily acyanotic, but is fatal without treatment after 2- 4 years and causes pulmonary hypertension, and in final stages Eisenmenger's reaction with right -to-left shunt and cyanosis and congestive heart failure ... The weeks after the first cardiac procedure weren't easy for the both of them. For the time of her hospital stay, she had a epimyocardial pacer, the leads will be removed when she gets discharged. It's just a precaution but sometimes even that is necessary.

In Meredith's case it was indeed neccessary.

Ellis Grey remembered watching the surgeons, who rushed Meredith in the OR.

It was totally unreal. When the surgeons were no longer visible, the general surgeon sat in the waiting room for relatives and waited. There were others two, waiting and hugging, some were crying. She never knew how it felt to be the family in the waiting room. And it was horrible. Minutes seem to become hours, hours days and so on. Time seemed to pass slowly.

She was pacing, checking her watch every three seconds. Finally, she went down to the cafeteria to eat- she had to keep her strength up.

She had a feeling that she would be spending here a lot of time. But it was good that they were taking their time.

 **In the operating room**

The surgeons just repaired the aorta. The surgeons opened her up through a median sternotomy and then put her on cardiopulmonary bypass machine which is required to take over her heart function, temp regulation and oxygen saturation. After the cannulation of the brachiocephalic trunk they stopped her heart with some kind of medication (pharmalogical cardioplegia) and let the CBM take over for now. But when you are working on the aorta, surgeons usually use a technique where they cool a body down and just perfuse the brain and that's what they did here too.

For a moment, only the beeping of the vent and the monitors could be heard.

The cardiopulmonary bypass had taken over heart and lung function as well as temperature regulation. The leading paediatric heart surgeon on the case just closed the ventricular septal defect trans-tricuspid. But it was a swiss cheese VSD. In the muscular septum was another hole and in the inlet septum too. A heart full of holes.

Meredith's heart was full of holes.

With continuation of cerebral perfusion the lead surgeon connected the aortic arch end to end and ventral augmented with a patch. Since the aortic arch was hypoplastic; which means it's too small and underdeveloped.

"Damn it, her aorta is hypoplastic. We'll have to perform a Yasui-operation." The lead surgeon said, throwing a glance at the head of his little patient.

Little and sick heart were his job. This was his job.

Fixing a heart

Trying to fix a heart ...

Giving the kid a shot at life ... that's what he was doing right now.

The surgeons performed a procedure called Yasui- operation, which means the cardiac surgeon anastomosed aorta ascendes und pulmonary artery side-to-side and extended it with a 8-mm polytetrafluoroethylene (PTFE) interposition graft from the ascending aorta to the descending aorta. In surgery they also did a pulmonary banding to prevent pulmonary flooding. However, they also discovered another additioning heart defect during surgery: Meredith also had an Atrioventricular Septal Defect (AV Canal Defect / Endocard Cushion Defect).

"Wait." The resident suddenly exclaimed as he noticed something.

"What is going on, Orenstein?" The surgeon asked gruffly. He was working very thoroughly, he knew that this girl was the daughter of a surgeon, of a colleague.

"Look, there is a hole in between the two atria." One surgeon said.

"What?" the other one exclaimed, he had not noticed that abnormality. He took a look himself and then only confirmed the other one's suspicion. There was another underlying defect here.

Another defect ...

Damn it.

"Damn it that complicates the whole procedure. What do we do now? Do we continue or do we close her up and only do a palliative procedure and then reopen her when she has gained more weight and is stronger to handle another surgery?" The assisting resident asked as he saw the extent of this, the extent of the defect. This was the important question, the question that determined everything following this.

"We close her up and then do a definite repair when she is three months or older." The professional tone of the lead surgeon showed no emotion.

He was cold, he has to be.

"Dr. Grey. We're here to update you on your daughter's condition." The older surgeon said.

"Is she out of surgery and in recovery? How are her sats, is she stable or ..." Dr. Grey asked, finally stopped pacing along the floor because she was worried. "First of all, your daughter is stable. We need to see if she makes it through the night. She'll need another surgery in a few months, when she is older and stronger. We have corrected the IAA, but not the Double Outlet left Ventricle. We also discovered ..." The doctor did not say anything straight out.

Ellis felt like he was hiding something.

She needed to find out what.

"What did you discover? There is no need to sugarcoat me." She demanded, her voice breaking slightly but soon she had the control back. "I am a doctor, a surgeon. So just tell me straight out." She demanded.

The surgeon nodded and answered: "In surgery we discovered an abnormal tricuspid and mitral valve. Also, she has an atrial septal defect that needs to be corrected in the next session and an Inlet-VSD. I am sorry." She has not signed consent on correcting the other defects. Ellis stared at the surgeon in utter shock and disbelief.

"What? You are kidding, right? This is not funny." She scoffed, not wanting this to be real.

Ellis didn't want to believe them.

How is she going to pull this off?

Without help and without a husband? How is she going to do this?

Her baby has a condition that probably will cause problems throughout her whole life and there was no one to help her. She was all alone.

Neither Thatcher nor Richard was here, she thought he was a wuss but still this was his child. Thatcher wasn't here, he didn't have to see his kid suffer through this.

She had no idea if she was strong enough for this.

And Richard, he'd gone back to Adele or something.

"We are serious. I am so sorry that we don't have better news for you." When the doctors told Ellis Grey about what they did find out while operating on her daughter's little heart, she just stared at them with disbelief and shock.

The world seemed to stop, she knew the freaking odds.

She could only picture the kind of life her kid is going to have. Nothing made any sense.

Nightmare, it was a freaking nightmare. You think you are _immune_ against something like this, but in the end, there´s no difference between you and the rest of the world. Some surgeons may think that, but it is definitely not true.

This was a freaking nightmare for every parent.

Meredith was born with a complete Atrioventricular Septal Defect (AVSD / AVCD), an Interrupted aortic arch (IAA), Double Outlet Right Ventricle with TGA-type / sub pulmonic VSD, which means she´s suffering from a Taussig- Bing- Anomaly. Life is not fair. Life is never fair, but sometimes life is really biting you in the ass.

"Do you want to see your daughter now?" The doctor asked softly. "Yes." She answered and then she followed the doctor to die Neonatal Intensive Care Unit. When she saw her daughter lying there with all these wires and the epimyocardial pacer coming out of her, she tried to show no emotion. She was Ellis Grey, future world-class surgeon and cold. But this 'no emotion' thing ain't so easy. But she held herself together until the doctor left her alone. She looked at heart monitor, her heart was beating regularly. It showed a normal sinus rhythm. She was glad about that.

"Meredith." She just said her name as she was holding her little hand. She was still intubated. They'd probably remove in a few days. She always knew that she wanted to name her daughter Meredith. It was such a beautiful name.

"Fight, okay? I just need you to fight." She whispered. "Mommy's here."

But she had no idea whether Meredith was able to hear her.

When Meredith was ten days post-op, she started having arrhythmias. JET. Junctional ectopic tachycardia. It often occurs in infants and children who had open heart surgery recently. Postoperative JET usually begins 6-72 hours following cardiopulmonary bypass surgery for repair of congenital heart lesions. It is usually identified during monitoring in the ICU. A fall in blood pressure and cardiac output usually occurs concomitantly.

Her monitors started beeping loudly as they signaled a fall in blood pressure.

In general, postoperative junctional ectopic tachycardia occurs in the hospital with rapid hemodynamic instability. The doctors also noticed a decreased cardiac output. They suspected she is suffering from one dreaded postoperative complications after correction of congenital heart fault.

"She's suffering from a post-op complication is what you're saying?" Ellis sighed.

"Yeah, we believe she has JET that occurs after surgery in some cases and leads to hemodynamic compromise." The doctors told her. Ellis had to sit down. This was too much too fast. She couldn't believe it.

"What will you do?"

"We'll start diagnosing and treating it."

The rhythm disorder usually occurs 6-72 hours after surgery, and the patient involved is hemodynamically most severely compromised. That was what they suspected Meredith had. Ellis was the first one who noticed the signs and symptoms and called the surgeon who immediately started doing the physical exam and work-up. Maybe the tachycardia developed due to direct Trauma to the AV node, inadequate reaction on reperfusion after removal of the extracorporeal circulation or the anesthetics might have been the cause.

Meredith had all these symptoms. Also, a VA dissociation has occurred, which is usually the case, cannon waves may be present in the jugular venous pulse. The intensity of the first heart sound varies when the doctors listened to her chest. Meredith let out a weak sounding cry. That is when she turned blue.

Like you know, it was only palliative and not a definite correction.

She will need another surgery in a few months.

So, Meredith continued to cry and because of the uncoordinated beats of ventricles and atria as well as the tachycardia and increased oxygen consumption rapidly developed cardiac decompensation in Meredith. "It's okay. They're going to help you. It's going to be okay." Ellis whispered, trying to calm her down.

They took blood from baby Meredith and sent it to the laboratory to get it assessed.

They assessed serum magnesium levels, electrolyte levels, and lactate concentration. The surgeons also did a chest film to see if ventricular dilatation and dysfunction there (when signs of pulmonary edema are present) in all patients with JET.

Meredith showed signs of pulmonary edema.

They also did a repeated echocardiography to significant postoperative residual hemodynamic abnormalities.

Without proper treatment in earlier post-operative phases, the mortality is high, also because the normal antiarrhythmics aren't working.

Since amiodarone is comsidered as the most effective treatment when handling cases with Junctional ectopic tachycardia, the doctors gave her an i. v. of bolus or a short infusion over 30 to 60 minutes at a dosage. They also treated her pulmonary edema because the amount of fluid build-up wasn't causing any good. It was worsening her current situation. Well, to Support the drugs, the physicians also decided to try AV sequential pacing therapy treatment, can help to restore AV sequence and cardiac output once the JET rate is reduced. Meredith's heartbeat slowed down after 39 hours.

They also treated her with anti-congestive medication like digoxin because of the low cardiac Output and the heart failure. When Meredith's condition got better instead of worsening, Ellis was relieved. She knew it was not easy to deal with.

Having a kid with heart failure wasn't easy.

And this was just the beginning of their journey.

* * *

Meredith was at home. She'd spent one month at Seattle Children's. Two weeks in the neonatal intensive care unit and the other two in the normal nursery but was monitored regularly. Ellis had her transferred right after the diagnosis. They performed the surgery at a different hospital that was specialized in treating those kids. Since two days and Ellis has no idea how to manage being the mother of a sick child. Nobody teaches that. Nobody knew her daughter was sick. She never even told Richard Webber that her daughter wasn't healthy, that she was someone who had special needs, needed to measured and weighed on a regular basis.

She also needed all sorts of medication that should prevent her heart from failing. Meredith needed a lot attention. She was connected to a heart monitor to monitor her heart. Ellis knew how to read that kind of thing. She felt more at ease using that thing in case something happens it would set off an alarm, if there was a significant drop in her pulse ox.

She always had ice-cold hands due to poor circulation. Sometimes, she turned cyanotic since it was not the definite palliative surgery. It was only the Yasui-procedure. The final procedure was still months away. Ellis had no idea how to manage that.

Her sick daughter and then her demanding work schedule. She'd have to cut back on hours immensely.

She had no choice but to do that.

* * *

 **A/N: So this is the Prequel to 'Nothing Turns Out The Way Its Supposed To' and follows Meredith's journey from her dramatical birth to where she is now, an intern at Seattle Grace Hospital where she meets Derek. It also explores Ellis' and Meredith's mother-daughter relationship. Cristina will also play a major role in this fic. Yes, I said Cristina and I mean Cristina Yang. They've come a long way ... and something happened and Cristina moved. But Mer and Cristina knew each other from their childhood. Without realizing it when they both start to work ...  
**

 **It shows how the great Ellis Grey copes with the fact that her daughter was born sick and there was nothing she could have done to prevent it from happening. Because sometimes, it just happens. Without an explanation for it.**

 **It's like Ellis Grey said: "The carousel never stops turning. You can't get off."**

 **Please leave a review.**


	2. Chapter 2

**Chapter 2 "A Long Way Ahead"**

* * *

 **After a trauma your body is at its most vulnerable. Response time is critical. So you're suddenly surrounded by people. Doctors, nurses, specialists, technicians. Surgery is a team sport. Everyone pushing for the finish line. Putting you back together again. But surgery is a trauma in and of itself. And once it's over, the real healing begins. We call it recovery. Recovery is not a team sport. It's a solitary distance run. It's long, it's exhausting and it's lonely as hell. The length of your recovery is determined by the extent of your injuries. And it's not always successful. No matter how hard we work at it, some wounds might never fully heal. You might have to adjust to a whole new way of living. Things may have changed too radically to ever go back to what they were. It might not even recognize yourself. It's like you haven't recovered anything at all. You're a whole new person with a whole new life.** Meredith Grey; It's A Long Way Back

* * *

"Are you sure she is stable enough to be discharged?" Ellis asked, sounding scared. "Yeah. We've been monitoring her progress very closely and for now, she is doing good, considering the defects she was born with and the fact that she was rushed into surgery after her ductus closed." The pediatric surgeon smiled at her, whose lips formed to a happy smile. The scar was there, red and going through the middle of her sternum. They had divided it. They had stopped her heart in order to repair it. For Ellis Grey that seemed unimaginable. She still couldn't think about what would have been if this had ended differently ... because it could have. Meredith not being able to come off bypass 'cause her heart is too weak to take up its function ... Then she would have been on ECMO. And that would not have been very good. "Dr. Grey?" The doctor asked as Ellis didn't react right away.

„Dr. Grey?"

She has seemingly spaced out, apparently. "Uhm, what were you saying?" She asked.

The doctor cleared his throat, then he repeated the sentence.

"We just need to confirm that everything is looking good with a post-op ECHO and of course electrocardiogram. She will have to take certain medication. She'll tire more easily than other babies her age. Meredith will need a lot of attention, a lot of help." The doctor said as he started listening to Meredith's heartbeat. "I am aware of that. This isn't the first time I have seen such a condition." Ellis replied to his question. "What meds will she have to take?" She then asked.

"I can tell you more about that after the ECHO. But for now, I think it's safe to remove the external pacer leads." The pediatric surgeon said. A lot of people have cared for Meredith during her stay at Seattle Children's Hospital. She was now a lot stronger than before the surgery.

But there was still a significant difference between her and a child born with a healthy heart.

"Okay, let's do it." Ellis said decisively as she cradled her daughter on her arm. Even though Meredith was now in a regular patient room, she was still attached to a portable heart monitor that was beeping rhythmically. "Ok, follow me." A nurse came and carried the monitor while Ellis carried her baby. They entered exam 5. Ellis saw the machine used to perform an echocardiography. Child-friendly figures could be seen on the walls in a lot of colors. "I will start by listening to the heart sounds." He explained. "i know. Just … do it, please. I know how this works. So do whatever's necessary." The general surgeon advised him. He only nodded. Meredith, who was still in her mother's arms, squirmed when he came nearer with that thing. "Sh, it's okay." Ellis murmured, noticing her child's discomfort. "It will be over before you know it." Upon hearing her mother's voice, Meredith was more willing to let the doctor do what he needed to do.

"Can I?" He asked in a soft voice he only used with children. With the heart patients he worked with ... and now it was Meredith Grey.

He had warmed the stethoscope before putting it on Meredith's chest. Apparently, Meredith appreciated the warmth coming from it and her arms were soon reaching for it. The pediatric surgeon started the exam with listening to Meredith's heart. Of course, there was a heart murmur since they haven't corrected every anomaly they found. They would have to do second surgery to take care of that. There was a sound coming from the ventricular septal defect and the atrial defect as well as the common AV valve.

"Yeah, I know you wanna try it out, huh?" The doctor chuckled as he interacted with Meredith.

Meredith giggled in response.

For once she was stronger than she was before surgery. Ellis Grey only nodded. Seeing the red and pink line across Meredith's chest, bisecting it ... She had a feeling that this wouldn't be all. That there would be a lot of more hurdles to go through … But it's better not to know everything ... if you did, when would you find time to enjoy life?

Then the doctor began with the ECHO. He felt Ellis staring at him as he evaluated the pictures. He turned the screen away from her so that she wouldn't see what the pictures showed.

"Hey, what the hell are you doing?" Ellis exclaimed as she lost view of the screen.

"I was just ..." He stuttered, knowing himself that it wasn't very professional but he just couldn't help it. "It's better if you don't have to see this, especially when you know how to read an ultrasound."

"Whatever, turn it _back_." Ellis said slowly.

She was very insistent.

"Please."

She added as he sighed and reluctantly pushed the screen back to where it was.

"Good." She only said in reply.

But he didn't think that Ellis would make him turn the monitor so that she can see what the screen was showing, what her daughter's little heart looked like. She saw the common AV valve, the multiple defects in the ventricular septum as well as in the atrial septum, the great arteries – both supplying the right ventricle, meaning the blood was mixed, resulting in cyanosis.

There was a high shunt volume. She saw that. Meanwhile, the doctor was quantifying the shunt.

But as the doctor pressed the transducer a little harder onto Meredith's chest, she started crying. It wasn't unsual for babies to do so when performing such a procedure. He knew a lot of babies did that. He'd seen a lot of baby hearts.

He'd seen a lot of responses like that.

After completing the exam, having looked at her heart in all the different modes such as four-chamber view, five-chamber view, parasternal view, M-Mode … the doctor put the transducer away and turned to Ellis who was still focused on the monitor. Meredith's heart was still on screen, frozen. "So, everything looks as expected after this type of surgery. There is less pulmonary flooding due to the pulmonary banding but there is still a significant shunt. You will have to come to a repeat ECHO every two weeks until definite surgical palliation can be performed."

"Isn't there any chance that the next surgery can be a corrective procedure?" Ellis asked.

But the doctor shook his head resignedly.

"Sadly, there isn't. But there are other options. From what I have seen your daughter looks like a good candidate for an atrial switch surgery also known as …" "… Senning procedure." Ellis interrupted him. "You know about those things?" The pediatric surgeon asked surprised. He didn't know that. Ellis looked at him, sending daggers at him with her eyes before saying: "I'm a third year surgical resident at Seattle Grace Hospital. You bet I do, I know about those things!" Ellis glared at him. The pediatric surgeon smiled lightly. "So I guess, I don't have to explain how this works?"

"I'm not in the mood of hearing medical terms and processing what they mean. So just talk to me as if I were any other parent with no medical knowledge." Ellis just said, breathing in tersely.

The pediatric surgeon turned to Ellis, clearing his throat before starting to speak.

"Uh, right." The doctor started. "An atrial switch operation is a surgery in which we create a conduit within the atria that reroutes the oxygen-poor blood. The anatomic left ventricle continues to pump into the pulmonary circulation and the anatomic right ventricle will work as the systemic pump, in other words the ventriculo-arterial mismatch is left unrepaired."

"Wait. I ..."

"So in other other words The left ventricle will pump the blood to the lungs while the right ventricle is working as the systemic pump?" Her voice shook.

"Yes." The surgeon said deadpan.

"Oh my ..."

"Do you need a minute to regain your senses?" The surgeon asked, trying to offer comfort, knowing that there wasn't much comfort that could be offered in such a situation.

"I'll send the nurse with discharge papers." He said. "This first surgery has been successful."

"I know. If it hadn't been, she wouldn't be alive." She sighed before asking a question she needed to ask, needed to know the answers for: "Is there anything I need to look for? Symptoms that indicate that she's getting worse? What kind of things do I need to look for?"

* * *

Meredith was at home. She'd spent one month at Seattle Children's. Two weeks in the neonatal intensive care unit and the other two in the normal nursery but was monitored regularly. Ellis had her transferred right after the diagnosis. They performed the surgery at a different hospital that was specialized in treating those kids. Ellis has no idea how to manage being the mother of a sick child. Nobody teaches that. Nobody knew her daughter was sick. She never even told Richard Webber that her daughter wasn't healthy, that she was someone who had special needs, needed to measured and weighed on a regular basis. She knew there would be additional surgery since this defect was too severe to get better on its own ...

But now she was standing outside Seattle Children's with her daughter's small body softly pressed against hers and full of gratitude. These doctors had saved her baby girl, giving her a shot at life with that surgery.

Without that surgery, she would have been dead by now.

It was a miracle that she survived. It has gotten noticeably colder and she saw that even though Meredith was soundly asleep, the cold seemed to bother her.

Then the cab she called arrived.

After Ellis put Meredith in a car seat and then sat down next to her, the cabbie asked for their destination. Without looking up, Ellis answered: "612 Harper Lane; Queen Anne Hill, Seattle." That's when the cabbie started driving. When they reached the house Ellis lived in, she paid and soon they were home, just in time for Meredith to be fed. "So, let's get you settled in." She murmured softly, knowing she was doing this alone.

At that moment, Meredith started crying loudly.

"Sh, I know you're hungry, just a moment then I'll be ready."

Soon, Ellis had warmed up a bottle of formula with additional calories – although she was sure, she would have to give her half of it through the feeding tube – and started feeding her. After a few minutes, Ellis noticed the growing drowsiness of her daughter. She almost started sleeping while eating. Meredith was still very slender, even for her age.

And then the problem with the eating ...

Ellis sighed. That's what was hard. Watching her baby not even being able to eat properly because it was so tiring for her.

She even had a feeding tube because she got too tired when trying to eat so they had to look into other options to make sure nutrition is adequate. That was because of the heart failure.

She had noticed that when she tried to feed her three weeks post-procedure. But Meredith had gotten too tired after only drinking a bit. She'd also been sweating so Ellis called the doctor and they decided it was best to try it with high-calorie formula that had special nutritional supplements added to formula that increase the number of calories in each ounce, thereby allowing Mer to drink less and still consume enough calories to grow properly. But even that hadn't worked and in the process, Meredith started losing weight which was alarming. So they opted for supplemental tube feedings given through a small, flexible tube that passes through the nose and into the stomach, so that when she got too tired to continue eating the rest of it would be given through the feeding tube.

After that, Meredith slowly started gaining weight and that was a relief for Ellis.

She also needed all sorts of medication that should prevent her heart from failing. They wanted to try and manage her heart failure by giving her Digoxin, that's supposed to help strengthen the heart muscle, enabling it to pump more efficiently, and diuretics to remove excess fluid from her body as well as ACE (angiotensin-converting enzyme) inhibitors that dilate blood vessels and as a result, they make it easier for the heart to pump blood forward into the body. Meredith needed a lot attention. She was connected to a heart monitor to monitor her heart. Ellis knew how to read that kind of thing.

She felt more at ease using that thing in case something happens, it would set off an alarm, if there was a significant drop in her pulse ox.

She always had ice-cold hands due to poor circulation.

Sometimes, she turned cyanotic since it was not the definite palliative surgery. It was only the Yasui-procedure. The final procedure was still months away. Ellis had no idea how to manage that. Her sick daughter and then her demanding work schedule. She'd have to cut back on hours immensely. She had no choice but to do that. But that was ok. She just hoped her superiors would understand why she was taking the maternity leave for at least half a year. But she would do that, sacrifice her work life for Meredith's well-being. But it wasn't Meredith's fault that she was born sick. It was not anybody's fault.

* * *

 **One month later**

Ellis was getting the hang of it. She knew what Meredith needed, how to calm her down when she was fussy. She had adjusted to her life as a mother of a kid with heart failure. It was an advantage that she was a doctor. She had a routine. First thing after waking up was feeding her baby, then giving her the needed medications she was on and then, depending on how well Meredith's state was, she went to the park with her. She wasn't old enough for the playground but the fresh air was good. One day as she was pushing her baby girl in a stroller she met Richard. "Hey, Ellis. Long time no see. When are you coming back to work. I miss having you there." Ellis frowned. "Well, it'll be awhile before I will be back, especially under these circumstances." Damn, she shouldn't have said that. It was a hint, a hint that signaled that something was wrong. Ok, something was wrong but there was no need for the whole world to know. "What circumstances?" He asked.

He was eyeing her cautiously, then the little baby. Thankfully she wasn't cyanotic right now.

Because then, Richard would know that something was wrong with her baby girl's heart (or lungs). He was a doctor after all. He wasn't dumb either. He'd figure it out.

"I just had a baby." Ellis sounded a little bit offended. "One and a half months ago." Richard said. "You basically lived in the hospital and now? What has changed?" He just wanted to understand. Her Chief was on the line, he wanted her to come back as soon as possible. Ellis Grey couldn't believe it. What the hell? She'd just given birth to a very sick baby girl that needed more attention than a healthy baby her age.

"However, it's nice to meet you, though. Adele wanted me to ask you if you wanted to come over for dinner. She wants to meet little Meredith."

 _Oh crap._

Ellis desperately tried to think of a reason that could let her avoid having to meet Adele and bringing her baby. She feared that this would be too much stress for her. Also, Meredith would have to go back to the hospital because of the second surgery. She knew it would be soonish. Also, there was a higher risk of her catching something before surgery and then they would have to postpone it which wasn't exactly ideal.

"Richard, I can't come to your dinner."

"But why not? You can come over and have dinner with us ... what's so wrong about dinner?" Richard Webber insisted on receiving an answer. What was so wrong about dinner? Maybe the fact that she didn't wanna face Adele …? Or that it would be awkward? A lot awkward considered they have had an affair over the last few months and now he playing happy family with Adele. No, she didn't wanna see that. "I have a child to care for." Ellis used Meredith as an excuse for not having to meet Richard and Adele since that would awkward.

A sick child …

"You can bring her, Adele and I would love to see her." Richard simply answered. "But sometimes things aren't this easy and this is one of those things. I can't bring her." Ellis insisted.

"Why can't you bring her? I mean I don't see a reason why you wouldn't be able to take Meredith with you?" He looked at the little girl in the stroller and on his face formed a bright smile. She really was gorgeous. "She's adorable." Ellis didn't know what to reply. What exactly should she say to that?

She can't, or more, wouldn't tell him that Meredith was sick.

Richard seemed to notice that she wasn't comfortable with talking about that topic so he switched to another topic.

"When will you be back at work?"

"Oh, is Jensen already talking about replacing me? I had a kid and I will back at some point. But right now I just go to work, knowing that some nanny is supposed to take care of my child." Ellis answered, her voice getting louder at the end of the sentence. Then there was silence between them and Richard knew that he had said the wrong thing. But now he'd already said and there was no going back. He cleared his throat. He saw that something was off. But he couldn't place it.

He looked at the baby that was sucking on her thumb.

"Ok, change of topic. What about the dinner?" Richard said awkwardly. "I'll think about it." Ellis avoided the topic. "It would be nice if you'd give me answer before Sunday, ok?" He asked. Ellis only nodded in reply. What else should she have said? After Richard wasn't there anymore, Ellis cursed herself for not saying no right away. Because she couldn't go to that dinner, could she? There was too much history, right?

She had no idea what to do.

A weak cry interrupted her train of thoughts. At that point she became more conscious of her surroundings and why she'd come to this park at all.

"Sh, everything's fine." She walked around so that she was facing Meredith. Carefully, she lifted her up.

Richard watched her doing that.

Then she rocked her softly so that she would stop crying.

"So, I just have to ..." Before she was able to finish that, she heard the ringing coming from the door. Probably the nanny, luckily she wasn't late. Ellis was relieved about that. Although she didn't really want to leave Meredith to go to that stupid dinner. But Adele and Richard had insisted and then she caved. But she wouldn't be bringing Meredith 'cause she feared that that would too much stress and too much to handle for her. So she hired a nanny. Ellis hurried downstairs when she heard that someone at the. That would have to be the nanny that is supposed to look after Meredith while she was attending that dinner. "Coming." She called out as the ringing came in closer together. "I will be there in just a minute." Meredith was upstairs, sleeping in her crib. She hoped Meredith wouldn't wake up any time soon. Then she opened the door and a middle-aged woman was standing in front of her. She was smiling in a friendly way. "Hello." Ellis was the first one to speak. "I'm Dr. Grey. May I ask who this is?"

"Anne Wilkins, we talked on the telephone. You hired me to babysit." The woman replied.

"Uh, yeah, I did. Come in." Ellis stammered.

Anne entered the house, looking around lurking. "So you've got a nice house here." She started making smalltalk. "I do. I have a dinner to get to, in about twenty minutes so let's make this short: My daughter's name is Meredith Elizabeth Grey. She's almost three months old and has had an open-heart procedure at the age of seven days. She spent her first month of life in the hospital and needs to take medication to treat her heart failure symptoms."

"WHAT?" The nanny exclaimed, she hadn't thought that the kid she'd be looking after, has major medical concerns.

Like congestive heart failure due to a congenital heart defect.

"Meredith has a heart defect. She needed surgery and there will be another surgery to complete the partial repair." Ellis told her about the cardiac condition Meredith was born with.

When she was finished she stammered: "Uh, okay. I can manage that."

At the end of the sentence, she was sounding more and more confident about the whole thing. "Good." Ellis replied.

"If something happens ..." She started giving instructions to the nanny who was standing there, facing Ellis. Anne listened to what she has to say. "... you call this number right here." She was now pointing at a note pinning near the telephone. She'd written down the number for Adele and Richard's landline in case something happened. She needed to take these precautions. "I will then instruct you on what to do next. If nobody answers, you call Seattle Children's Heart Center and ask them if you should bring her by for a consult and try to reach me. You got that? This is important."

"Where is she now?" She then asked.

"She's upstairs, sleeping."

They both went upstairs and Anne met Meredith for the first time. She was soundly asleep but looking so small. "So now that you know, I can go and make it to the dinner party or whatever it is." "Yeah, you can go. I got this." Anne smiled reassuringly. Ellis turned around and scurried to the door. She didn't stay very long at the dinner party, only one hour before she excused herself. She didn't like talking to Adele as if she and Richard weren't ... That seemed wrong.

Wrong in so many ways.

When she got home, Anne had just started to feed Meredith. Ellis opened the door and entered her house. Her keys were in her hand, jingling. She ignored the sound. "Hello, I'm back home." Hoped she'd get a reply and not find a note telling her to get her ass to Seattle Children's immediately due to some unexpected emergency. "We're here." Anne called back.

Ellis breathed in in relief. She took off her coat and shoes and walked into the living room.

Anne was sitting there, with little Meredith on her lap and feeding her carefully, the heart monitor sitting next to them on the couch, beeping steadily. "Were the any problems?" Ellis wanted to know. "No, no problems. But what I noticed was that she was ... her breathing was very laboured at some times, she turned blue a couple times - nothing big but I thought you should know. Anyways, I cooked dinner. There's still food for tomorrow, you can warm it up then."

"Oh, you didn't have to do all that." Ellis said gratefully. "Thanks, though."

"Not a problem at all."

Ellis eyed the bottle suspiciously. Meredith apparently hasn't drank that much. Damn it, this wasn't good. After they talked about payment, Ellis said bye to Anne. "You can call me if you need me to babysit again. I'm happy to do so." Anne said to Ellis. "And if I don't see her before her next procedure, good look. She's a fighter. She'll do it."

"Thanks." Ellis smiled softly. Then she left and Ellis walked into the living room, put Meredith back into her crib while getting her stethoscope. She wanted to check for abnormal breath sounds. She saw she had gained weight but she presumed it was due to edemas. She knew this was crazy but she just couldn't help it. Also, Meredith seemed lethargic and she seemed to have trouble breathing. She would have to take her to Seattle Children's to determine whether it's safe to wait with the surgery or not ... She can't decide that.

"Oh, no, this is not good." She murmured as she listening to her lungs.

Meredith was admitted three days before the actual procedure should take place so that they could perform the necessary exams before surgery to make sure they could plan the exact approach. But they also wanted her to stabilize while getting her pulmonary edema treated. Meredith's previous symptoms that started the night she went to visit Richard and Adele and they worsened so Ellis Grey decided to come in for a consult. She wouldn't take any chances. And it turned out, she had pulmonary edema caused by heart failure. They couldn't postpone/push the surgery anymore. They had to do it now. "We have to do the surgery now. We'll let her rest for two days and then we'll do the surgery." The cardiac surgeon said. Meredith was now three months old. Now the second and hopefully final surgery would take place.

He then put the transducer aside. He'd just performed the ECHO on Meredith.

"She's in florid heart failure. Her EF is falling precipitously." He then said. "What is her ejection fraction? Tell me, I want to know." Ellis insisted, breathing in deeply before exhaling.

This was hard, and it was about to get even harder.

"EF is 40 and falling."

"Oh, shit." Ellis exclaimed shocked. This was very bad. "There's pulmonary edema. We need to treat it, and see if we could get her EF up." The doctor said.

"We plan on performing an atrial switch invented by cardiac surgeon Senning. Due to the complicated relationship of the great arteries an Arterial Switch Operation is not an option, so the only options were: Atrial Switch Operation or Damus- Kaye- Stansel- Operation." He told her. Ellis glanced over to Meredith's bed. She was asleep and didn't know what was about to happen to her. Ellis was glad she didn't know, that she was so young.

If she was lucky, she'd never remember anything about this.

"So atrial switch it is?" Ellis shook her heart.

She knew that meant that her daughter was facing the risk of right-sided heart failure (that presents with left-sided heart failure symptoms) since her right ventricle was acting as the systemic ventricle. "Yeah, we're doing a Atrial Switch Surgery." He confirmed. Which meant that there was no way to correct the underlying defects of the heart. But since Meredith has no high grade sub-aortic stenosis, the surgeons tended to the other surgery: Atrial Switch Surgery.

At least that's what they told Ellis.

 _There's a perfect window - if you wait to long before doing the surgery it may be too late for a repair._

The next day, Ellis had spent the night at Meredith's bedside. She would have enough time for getting something to eat later on when they start to operate. They wanted to wait six months but they were doing it now because something had happened. And the pediatric cardiologist said that he'd want to schedule the surgery earlier to prevent new problems from forming.

"So we have to your daughter up to surgery now."

"But why?" Ellis couldn't understand. She wasn't thinking like a doctor, more like a terrified parent.

Because this girl was her child, her only child.

"You said you wanted to wait until she was six months old. She's three and a half months old. She's underweight, too small. Will she even survive this?" She wanted to know. The lead surgeon looked at her pitifully. "I can't promise anything. I hope she will. But I can't say for sure." He stammered slightly, while looking at her somberly.

"Right, you never promise someone a good outcome." Ellis muttered under her breath. Then they took her baby up to OR. She was standing there in the waiting room, ready to break down. But Ellis Grey didn't break down. So she put on a brave face and sat down, unmoving. But internally, she was screaming at he unfairness of the world. How could it be that her baby needs risky open heart surgery _twice_?

At some point, she just couldn't sit there any longer. She stood up and began to pace ...

* * *

During heart surgery, the anesthesiologist monitored Meredith's vital functions, including blood pressure, temperature, heart function and oxygen levels in the blood while the surgeons were performing the surgery. Alternatively an atrial switch by Mustard would be a different course of treatment. The only difference between Senning and Mustard is that by the _Mustard-Method_ is used foreign material and _Senning- Method_ use in reverse to _atrial Switch by Mustard_ the patient's atrial tissue. But that was not the only option. The REV method (réparation à l'Étage ventriculaire), an intracardiac tunnel or Rastelli- operation would have been possible treatment options for a "double outlet right ventricle" with an sub aortic ventricular septal defect, but since Meredith's VSD was sub pulmonic these surgeries weren't a doable option.

In the atrial switch operation, the atrial tissue is cut so that the system venous blood passes through a so created pant shaped atrial tunnel and it gets into the pulmonary artery. The pulmonary vein blood flows past the tunnel in the right ventricle. Meredith' ventricular septal defect was closed with a tunnel patch that passes the blood from the left ventricle to the pulmonary artery. At the same time the AV Canal Defect has been fixed with the double patch technique. In the double-patch-technique cardiac surgeons closed the Ventricular septal defect and atrial septal defect with two different patches.

After VSD closure with the first patch the bridge sails of ASD were fixed with assignment to the ventricles at the patch, sewn the "cleft" and closed with a second patch.

This method is more complex than the single-patch technique. However, in this case the fragile AV valve tissue must not be incised. After they were finished with the whole procedure, the heart surgeons started to warm her up and let her heart beat on her own again but there was a problem. The heart-lung machine slowly stopped rotating. The surgeons were hoping that her heart would pick up where it left off and start beating but that wasn't the case. The lead surgeon also implanted an external pacemaker in case of arrhythmias. But that was just precaution and therefore only transiently and will be removed once she gets discharged. They weren't able to get her heart to beat on its own.

"Let's try again." The older and more experienced surgeon said. "Guys, she's getting unstable and harder to ventilate. If you're going to do something do it now, fast." The anesthesiologist interjected. After two failed attempts in taking her off cardiopulmonary bypass, the lead surgeon decided it was best to initiate ECMO, a modified form of CPB. "Damn it." He murmured.

"Let's initiate ECMO so that she has a shot."

He knew what that meant. Survival rates weren't very high in those cases.

"Ok, that's it, we're initiating ECMO." After hearing those words, the entire OR fell silent. The only beeping that that could be heard was the medical monitoring equipment. The lead surgeon looked at the oxygenation of his patient, sighing. The perfusonist asked since there are two types of ECMO: "What kind of ECMO seems apprioprate?" The pediatric heart surgeon looked up from the surgical field before answering: "Prepare for Veno-arterial (V-A) ECMO. That allows her lungs and heart to rest. Veno-venous (V-V) ECMO is used when the heart is functioning well and only the lungs need the support of the circuit."

Then he turned to his intern he is supposed to teach. The mother of the girl he was operating on almost freaked out at him when he told her that an intern would be observing the procedure. She didn't want any amateurs doing the surgery, she was the best – experienced surgeons operating on her daughter. "Have you ever hooked aa baby up to ECMO before?" He asked the intern standing there, watching the procedure. The intern only nodded, still shocked from what just happened.

"I hope you take notes because you're about to see your first ECMO that's being initiated in the operating room." The lead surgeon said, barely looking that the intern.

"But before we get started what is ECMO?" The young intern stuttered a bit before answering: "It provides … it … provides long-term breathing and heart support. Extracorporal membrane oxygenation is typically reserved as an extreme supportive measure when more conventional measures have failed. The baby can be on ECMO for days to weeks."

"Ok, enough with education. Let's get this show on the road. Preparing for ECMO."

"Are you ready?" They placed the cannulas connecting the patient to the ECMO circuit directly into the large blood vessels adjacent to the heart, similar to the connections made during open heart surgery. "Ok, now we have to connect the cannulas to the tubing." The surgeon announced. The cannulas were connected to the tubing of the ECMO machine and bypass circulation began. The lead surgeon heaved a sigh, knowing that he would have to tell the mother about what just happened in surgery. ECMO was initiated in the operating room immediately after her surgery to allow the heart to recover from surgery. "Ready to release clamps …" The lead surgeon announced, his eyes were on the cardiac monitor, looking for any changes in the oxygen levels. He was hopeful that this was the right approach even though it was very aggressive.

"Release clamps."

Then shortly after, the younger surgeon said, slowly releasing the arterial clamp while saying: "Arterial clamp off."

"Venous clamp off. Pump on." The lead surgeon said, hoping there would be an increase in oxygen saturation. The machine started whirr. All personnel looked at the monitor. After a seemingly very long minute, Meredith's pulse ox went up to 95%. That was definitely good.

"Starting to close up …" He informed, knowing there would be an increased risk of infection, renal failure and failure of the heart to recover adequately but it was worth a try. There was also the risk of bleeding. But he was also scared of Ellis Grey. Of telling her that her daughter was currently living because a machine has taken over heart and lung function for the time being. At least until she stabilized. "Let's get her to pediatric cardiac intensive care unit." He ordered as he left the operating room to scrub out. Now he had the ungrateful task to update the mother of this child.

... who was no other than Ellis Grey herself.

He'd heard about the first female surgeon starting her residency at Seattle Grace and now he just operated on her daughter. It was really freaking unbelievable, just as so many other things in life.

* * *

 **A/N: I hope you liked it ...**

 **Here's some extra information about ECMO: Extracorporeal membrane oxygenation, or ECMO, is a treatment used for patients with life-threatening heart and/or lung problems. It provides long-term breathing and heart support and is used only when all of the standard treatments for those problems have already been tried. ECMO can support patients for days to weeks while doctors treat their underlying illness. It's used in treating infants with: Meconium aspiration syndrome (MAS), Persistent pulmonary hypertension of the newborn (PPHN), Congenital diaphragmatic hernia (CDH), Respiratory distress syndrome (RDS), Pneumonia and Congenital heart conditions. There are several forms of ECMO, the two most common of which are the veno-arterial (VA) and veno-venous (VV). In both modalities, blood drained from the venous system is oxygenated outside of the body. In VA ECMO, this blood is returned to the arterial system and in VV ECMO the blood is returned to the venous system. In VV ECMO, no cardiac support is provided (Source: CHOP)  
**

 **Please review.**


	3. Chapter 3

**Chapter 3: "Live Or Die"  
**

* * *

 **There are medical miracles. Being worshippers of the altar of science, we don't like to believe miracles exist. But they do. Things happen. We can't explain them, we can't control them, but they do happen. Miracles do happen in medicine. They happen every day, just not always when we need them to happen. At the end of a day like this, a day when so many prayers are answered and so many aren't, we take our miracles where we find them. We reach across the gap and sometimes, against all odds, against all logic, we touch.** Some Kind of Miracle; Meredith Grey

* * *

When Ellis saw the surgeons coming toward her she knew it couldn't be good.

She had a feeling and now that feeling proved to reality.

Something had happened in surgery. And that something wasn't a good thing. She felt that in her bones. The face expressions of the surgeons who had operated on Meredith looked exhausted as if the surgery had been very long and difficult.

She shot of from the seat she'd been sitting on for the past few hours.

She had tried to study but her brain wouldn't allow it. She couldn't think, couldn't make sense of the words in the medical book. That never happened to her before. Before all of this happened – when she still thought that her baby girl would be born with a healthy heart …

But that vision has been shattered in a million tiny pieces that just won't fit together, no matter how hard she tried. She was now a single mother of a sick child. Meredith will need lifelong follow-ups and maybe interventional procedures if necessary. "Dr. Grey, we're here to give you an update now." The younger surgeon said, his voice a bit insecure as if he wasn't used to giving people bad news. What if she died in surgery?

They hadn't come this far just to face the fact that her daughter was gone for real now?

Now she knew how it feels to be someone in the waiting room. Before this, she'd been the one operating or more, assisting. Now she knew the feeling of being useless while waiting for someone to give her an update. And it was horrible. She'd never felt less alone.

She looked to the ground, wanting them to her that everything went perfectly and that Meredith is being monitored in neonatal intensive care unit.

But somehow she knew that it would come different.

"What happened?" She said in an edgy voice, strained as if she knew what they were about to tell her.

"I don't know how to explain this … We couldn't have seen this coming …" The older surgeon stepped in as he saw what this stammering did to the patient's mother.

"Is she dead? Are you saying she's not alive?" Ellis' voice resembled someone in sheer panic.

"Please don't tell me that she's …"

Ellis was terrified, like she'd never been in her life.

She never knew that feeling before her daughter was born.

"No, Dr. Grey, your daughter is not dead. She's in post-anesthesia care unit and will be kept there until her room in pediatric cardiac intensive care unit is ready and prepped. We were able to complete the procedure."

Pause. Ellis swallowed drily.

"Her right ventricle will be acting as the systemic ventricle instead of the left. I know that that is hard to understand but you will get there. But there is something else we need to tell you."

The surgeon paused, not really sure how he should her about Meredith dependent on ECMO.

"Will be acting?" Ellis asked, catching up on what the doctors just told her. That wasn't present tense. It was future. "Will be acting? How come?" She repeated shocked, trying to wrap her mind around things. The surgeon gazed at her empathetically before continuing to speak.

Oh no, this couldn't mean anything even remotely good.

"There were complications at the end of the surgery and we weren't able to take your daughter off cardiopulmonary bypass." She knew it. She had known it. That there would be SOME kind of complication and of course it would be Meredith who is suffering from it.

At first she was shocked, so shocked that she could not really form words into coherent sentences.

"How … what … why … what are you saying?" Ellis stuttered overwhelmed. She was the only on in the waiting room that was empty besides her and the surgeons updating her on Meredith's current state.

"You haven't been able to … oh …"

Realization dawned on her.

"We're sorry but your daughter is currently on extracorporal life support. We have initiated ECMO." The lead surgeon stepped forward as he saw that his younger and not so experienced colleague struggle with giving her the information.

So he decided to step in.

That kind of procedure was relatively new and untried. But apparently, it was the only chance they had and she would be damned if she didn't take that chance to make it possible for her to survive this.

"But that's … new." She stammered.

"We are aware of that. But we believe this is her best shot and your child isn't the first one to be treated with this treatment." "But what about the success rates, they aren't that high yet are they?" She murmured. She said that sentence more to herself than somebody else. Ellis then turned back to the surgeon.

"How, why is she on extracorporal membrane oxygenation?" Ellis asked a bit louder, her voice caught.

A machine has taken over the function of Meredith's heart and lungs for a limited time until the she recovers from the initial cause of the failure.

Her heart needed the support.

They weren't sure what it has caused. They were clueless up until now.

"We weren't able to get her heart to pump on its own. We did transthoracic cannulation of the right atrial appendage and the aortic arch. This allows left heart decompression by cannulation of the left atrium. This is useful in patients with primary left heart failure. So we are …"

"… basically waiting for a miracle to happen." Ellis cut them off.

For a moment there was silence.

"This is all you have got to say?" Ellis couldn't believe it.

Meredith was now barely hanging on.

This couldn't be it.

"Do you know why you weren't able to get her off bypass?" She demanded answers.

"No, we don't."

"So you're saying you don't have any answers at all? That this is the _wait-and-see_ -part, am I right?" Ellis asked.

"But you also know that most post-open-heart surgery patients who require ECMO are supported for approximately three to four days, so chances are that we'll be able to wean her off ECMO then. But if that's not the case, this can be continued up to two to three weeks, if indicated." Ellis just stared at them shocked.

She couldn't believe what she just heard.

"Dr. Grey, we're so sorry that we don't have better news. All we can do now is to wait and see if she stabilizes on her own. It may take a while before we're able to take her off that machine that has now taken over her lung and heart function." Ellis didn't reply. Sorry has no meaning. In that moment, it has no meaning.

"What happens now?" She asked in a roughed up voice.

The lead surgeon motioned for his younger colleague to step up and talk her through it.

"We'll evaluate cardiac function on a daily basis to determine whether a patient is ready to be weaned from ECMO. That's based on clinical course, blood tests and postoperative echocardiographies performed bedside. It's crucial that you don't touch any of the circuit. Your daughter's life depends on that machine. Of course she'll be on a vent and there will be a lot of lines …" Ellis cut him off. "I know how someone looks post-op. I've been there before." She replied hastily.

"We don't doubt that but it's different when it's someone you love." Ellis looked like she was about to cut him off again before she was able to do that, he asked: "Do you want to see her now?" Ellis nodded in reply.

Of course, she wanted to see her. "Follow me. I'll take you to her now." The younger surgeon said.

The other surgeon went to complete some post-op notes.

* * *

 **Day 1**

"You need to wear this." The surgeon informed her, handing her a pink gown used for neonatal and pediatric intensive care units. Ellis didn't reply anything. She just took the gown from his hands and put it on. She wanted to see her daughter. "Can I see her now?" That was her next question. "Don't you know the protocol?" He answered. "Right, I need to wash my hands." Ellis replied tiredly. Of course there was that, how could she have forgotten that? After she did that, the surgeon pushed the button with his foot and the door opened. He then led the way to her daughter.

When Ellis saw the machines connected to her daughter, she gasped.

There was barely a piece of skin to find that doesn't have anything sticking out of it. All she saw were medical devices standing around her, always something was blinking or beeping or just making some sort of noise. Ellis breathed in deeply. She already knew that this recovery would be long and hard for the both of them. It hasn't looked like this the last time.

Now it seems like everything was somehow different. And it kind of was. Now a machine was pumping her blood through her body.

Not only during surgery but also after surgery and that was shocking, even for her.

But last time, they had been able to get her off cardiopulmonary bypass after surgery so that there were only those things she's already seen before. "Dr. Grey, do you want me to explain to how this works?" He asked. Ellis scoffed. "As if that would help with the situation …" She murmured under her breath.

"No, I don't need you to explain how this works. I know how this works. I haven't seen this before but I read about it. That's how I know how extracorporal membrane oxygenation works." She continued, while taking a deep breath. She remembered reading about this new technique not so long ago.

The doctor fell silent, watching Meredith's vitals on the monitor, and checking the settings on the machines. A higher PaO2 is achieved as well as the machine provides support to assist the systemic circulation, he noted. Everything was looking okay

Then he turned his attention back to the patient's mother who hovered over her child while reciting how this works.

"It means that blood drains from the left side of the heart through the venous tubing and is pumped through the membrane oxygenator, also known as artificial lung, which takes over the work of the baby's lungs. The blood is then rewarmed and returned to the body through the arterial cannula. It practically bypasses pulmonary circulation." Ellis ended her explanation. "I see you know what ECMO does. But there are some things we still need to talk about." The doctor started gently, not wanting to overwhelm her.

"What kind of things are you talking about?" Ellis wanted to know, her voice was shaking slightly. Then the doctor started telling her about what medication her baby girl was on and how they were working, what they were for and what the risks are.

The cardiac surgeon glanced at her fully before starting to talk: "As long as your child is on ECMO, heparin is given. It's an anticoagulant also known as blood thinner, meaning it prevents clots from forming in the tubing of the circuit."

"She gets heparin? So she's at risk for bleeding from her suture lines." Ellis concluded.

The physician heard the shock that dulled her voice, making her sound completely desperate. "She does along with other medications that are necessary for her recovery." He added after glancing at her chart. The doctor looked how well this was working by checking the safety devices and monitors that were monitoring pressure in the circuit since an increase of that pressure is dangerous. Those monitors show numbers that don't make any sense to someone who wasn't a medical professional.

"What kind of medication?" By now the doctor must've figured out that he was dealing with someone who knows about medicine. "We have her on inotropic agents to enhance native cardiac output. Also, patients on ECMO require close monitoring of electrolytes and fluids."

"Oh my, I never expected it to come down to this." Ellis breathed in deeply. This feels unreal, definitely unreal. "We're doing absolutely everything we can to help your little girl to stay alive and fight this."

"What would you do if you were in my situation?"

Ellis had no idea why she asked that question. What would it help her to ask that question? She didn't know.

"I can't really answer that question. Nobody knows what they would in such a situation. But if it were my child … I would spend as much time as possible with him or her. At least I'd want to. Also, friends and family are important as a support net."

"What family?" Ellis muttered under her breath.

"The only family I have is currently alive due to a machine taking over heart as well as lung function and temp regulation. So, the family and friends part of this whole thing is a little more complicated than previously thought." The doctor looked at her for a moment. "But support is important. You need support. I've seen parents go through what you are going through. But they weren't doing it alone."

"Was their child on extracorporal membrane oxygenation?" Ellis snapped at the poor guy. The doctor shook his head.

"No. But the majority of children born with CHD need at least one invasive surgery in their lives, sometimes they require more than one surgery. Those children also need intensive care right after their surgery. What I'm trying to say is that they had the support of their families."

"Well, I don't." For a moment, only the continuous beeping of the machines could be heard.

"I'll now give you time to process. Have the nurses page me if something happens. And remember, don't touch the circuit. That is really important." He repeated once again. "I know I'm not supposed to touch the circuit." Ellis Grey looked at him briefly before turning her gaze back to her daughter.

"I know this machine is keeping her alive and that touching the tubing does more harm than good. I'm aware of that." Ellis answered.

"Good." He simply replied, leaving her alone in the midst of continuously beeping and blinking machines. After the doctor left, Ellis sat down on a chair they left in the room and let her glance slide over her daughter. She couldn't believe this.

She had an intravenous catheter placed to provide IV fluids and important medication that are needed. Ellis could also make out arterial line, a specialized IV placed in the wrist that measures her blood pressure continuously.

She was also dependent on the support of the ventilator but that was to expect considering she was currently surviving on ECMO.

The general surgeon let a glance slide over the circuit. She could make out the roller pump that they use in neonatal patients instead of the constrained centrifugal pump. That pump is responsible for pumping the blood. She could also see the membrane oxygenator that exchanges oxygen and carbon dioxide and the heat exchanger regulating the temperature.

Right now she really wished she wouldn't have to do this alone. How come she ended up alone with this? She should have known better. But maybe there was still a chance that Richard would choose her at some point but that chance was small, very small in fact. As for Thatcher, she hated him for leaving his daughter before she was even born.

Who does that?

Only he did that. And now this – her baby surviving on ECMO… It still seemed unimaginable.

Why does everything have to be an uphill climb?

At least she was still alive, meaning she had still a chance.

* * *

 **Day 3**

Nothing had changed. Except, Ellis has started drinking more cups of coffee than usual.

She was tired. But that was probably stress-related when considering the fact that there was a lot going on in her life. She yawned and for a moment she fell asleep, her head softly bumping on the table. She almost fell asleep instantly. She woke up after four uninterrupted hours of sleeping but she was still feeling tired.

But at least she had a little more energy than before.

In that moment, a pediatric nurse entered the room, seeing Ellis obviously very tired with red eyes and puffy cheeks. "Is there anything I can do?" She asked after checking Meredith's vitals and the circuit. But everything checked out ok. The ECMO apparatus was working.

Dr. Ellis Grey was grateful for that.

Ellis knew she had to ask this question even if she knew the answers.

"Wait." Ellis turned and the pediatric nurse stopped and turned to her. It was the one Ellis favored because she was always nice with Meredith. "I need to ask something. I know I am supposed to know those things but right now she just wasn't in the mood to deal with medical jargon. The pediatric nurse looked at her, advertent as if she was waiting for her to say something. She didn't say anything. "Dr. Grey?" She said after a few seconds of silence.

"How do we know that she will be able to come off bypass?" She asked the question.

She needed to know.

"Let me page the doctor." She answered softly. "I believe he will be here soon to round on you." That detail caught her attention. "With interns…?" Ellis asked alarmed. But they aren't allowed to touch anything so much is clear." She said, almost immediately.

"Yeah, with interns since this is also a teaching hospital." Ellis nodded. She didn't know if she wanted a group of interns staring at her baby. But she was an intern once. After the nurse left, Ellis continued to stare at her daughter. Eventually she was noticing that she was tired. Soon, the on-call pediatric cardiologist and his interns/ fellows entered the room. Ellis was stirring in her cup of tea, completely lost in her thoughts.

"Dr. Grey." The attending tried to get her attention. Ellis flinched before she looked up. "Uh, yeah, right, it's time of rounds." She said after glance at the clock. She saw the faces of the pediatric heart surgery fellows.

"Dr. Pratt, please present." The attending gave the order.

"Meredith Elizabeth Grey, a three month old infant, three days postop an open heart procedure due to Double Outlet Right Ventricle with TGA type also known as Taussig-Bing-Anomaly, additional defects were complete AV canal defect and interrupted aortic arch. They did an Yasui procedure when she was one week old and the last surgery that was done is considered definite palliation. The last surgery was an atrial switch procedure combined with repair of the AV canal defect. But due to difficulties they weren't able to get her off cardiopulmonary bypass in the OR. The patient is currently on extracorporal membrane oxygenation and doing stable for now."

Then he was finished. But his attending had other ideas in mind.

"Elaborate, please."

Ellis watched the fellow explain. Dr. Pratt sighed and started to explain. "So when do you think she can come off bypass?" Ellis asked, hopeful despite knowing that the odds weren't very good. The prognosis for children on extracorporal membrane oxygenation due to cardiac indications was bad.

"We'll have to see."

The machine is pumping oxygen-enriched blood through the body, supplying the brain, heart, kidneys, and all other vital organs and tissues and it's also responsible for the oxygenation. As the heart function improves, the amount of blood flow through the circuit can be decreased, allowing the heart to do more of the work." The pediatric cardiologist says, hoping he could be helpful. "But we can't say when her heart will be ready."

But he could only give her a very vague estimate of when Meredith Elizabeth Grey would be able to come off ECMO. She expected that. But it was still disappointing.

Hours later, a nurse came in, addressing Dr. Grey.

"I just got a call from the reception downstairs. There's a woman waiting for you, saying she's a blood relative."

Ellis stared at her shocked. She didn't expect that at all. She was really surprised that at least one of her family was here. But the others? She guessed it was Catherine. Only she remained in contact with her. After all these months she was finally getting off her ass and visiting them? What about when Meredith had her first surgery?

Ellis shook her head. She didn't want to deal with this now. But eventually, she would have to. "Should I send her in?"

Ellis shook her head. "I'll go meet her in the lobby."

"Okay then." The nurse replied.

The soon-to-be-surgeon gazed back at Meredith before inhaling sharply.

She saw the nurse leaving the room, probably on her way to inform her sister that she was on her way to meet her.

"Don't pull anything funny." She whispered to Meredith but there was no reaction at all. Then she left the floor to go downstairs where her sister was waiting for her. When she reached the lobby she didn't have to search long before she saw her sister sitting in one of the chairs, obviously waiting for her to come.

Ellis stopped for a second. Her sister hadn't seen her up until now. Now she turned around because there was some commotion. Someone was arguing loudly about something. It turned out to be some patient's family. Ellis turned her attention back to where her sister was sitting and in that moment, her sister noticed her presence as well.

She slowly got up from the chair she was sitting in.

When she walked nearer she saw the hardened look on Ellis' face. A look she knew all too well. "What are you doing here?" Ellis asked coolly, a biting tone could be heard. Her sister flinched when she heard Ellis harsh response. "I'm here for support." "I could have needed that shortly after I gave birth to a baby girl who has a highly complex cardiac condition. I could have needed support then." Ellis Grey gave back, her arms crossed over her chest. Catherine sighed. She should have known her sister wouldn't exactly welcome her open arms, especially in this situation.

"I know. But you do need support now." Her sister insisted.

"We've been doing just fine." Ellis replied shortly. A couple happily talking was passing them. Apparently, whoever they just visited was doing good in contrary to Meredith. "How is she doing?" Her sister wanted to know.

Ellis huffed but didn't answer.

"Ellis? That was not an answer."

When Catherine used that voice, Ellis felt like she was a little kid again with her hands in a cookie jar, telling her mother she didn't do it.

 _Fine_.

"A machine has taken over heart and lung function as well as temperature regulation because Meredith isn't able to do any of those functions herself."

As soon as she said this, there was silence.

Shocked silence.

"So she's not doing so good." Catherine concluded, a frown appearing. She worried about her niece. She hasn't seen her before.

"She's not doing so good, that's in fact right." Ellis repeated this sentence silently.

"Can I see her?" Catherine looked at her sister tentatively.

She had the slight hope that her younger sister would agree. "Sure." Ellis smiled faintly. She remembered the words of the doctor whom she talked to. What he said about needing support from the family. Right now, Catherine was the only family she's got except Meredith. But Meredith wasn't even conscious. She was sedated so that she wouldn't have to feel pain and fear that comes along when _this_ happens.

Both of them walked to the elevator. Ellis showed her the way to the pediatric intensive care unit.

When they were at the correct floor, Ellis took Catherine aside. "Look, before we go in there you need to prepare yourself. She … there are a lot of monitors and devices monitoring her vitals and the circuit, well, it is keeping her alive. It's doing the work of the heart and lungs."

Catherine nodded, she pressed her lips together.

"Let's go visit Meredith."

Catherine was worried but also kinda excited about meeting her niece for the first time. Of course, the situation sucked and everything and for sure, she'd imagined that she would be meeting her niece under different circumstances. But she looked forward to seeing her for the first time, despite the terrifying circumstances.

But she wasn't prepared for what she was about to see.

A small baby. In a bed that seemed way too big for her. Tubes sticking out of her everywhere.

She let out a shocked gasp.

She couldn't even begin to imagine what this must be like for her sister.

"This is ..."

"I know." Ellis replied silently. This freaking nightmare should come to an end, rather sooner than later.

But until then, there's nothing left to do but to wait and see.

* * *

 **Day 4**

There hasn't changed much. Her sweep numbers were pretty much the same.

At least there weren't any complications that come along with the use of ECMO.

Ellis knew the odds.

"Ellis, you need to take a break. You don't need to sit there every day and night." Her sister tried to tell her but Ellis wouldn't listen.

"I do. I have to." She replied stubbornly, rubbing her eyes tiredly. No matter how hard she tried to deny it, she really was tired and her tiredness was growing. She could feel that her older sister was annoyed with her.

Catherine knew her sister was denying any problems.

Ellis was good at denying that she was having any problems.

She always has been good at those things.

"How long has it been since you had a decent meal? What about sleeping? This isn't going to help her." She motioned to Meredith who was still on ECMO. A doctor entered the room, carrying some supplies. "What are you doing?" Immediately Ellis' focus was on the doctor. The doctor turned around to face her, in this moment also a nurse entered the room.

Soon, the room got a little crowded.

"We plan to do some imaging tests at bedside to monitor your baby's progress, including X-rays to check the location of the cannulas and monitor inflation of the lungs; ultrasound of the head to check for intracranial hemorrhage and an echocardiography to assess how the heart is doing as we attempt to wean your baby from ECMO support." An elder doctor said as he entered the room.

He was pushing some heavy machine that Ellis recognized as an ultrasound machine.

The younger colleague looked up from what he was doing and started to explain.

"I have to take her blood to know if we need to adjust anticoagulant medications that are given during ECMO support and check her hemoglobin and hematocrit levels in the blood." They also did an arterial blood gas to monitor the oxygen/ carbon dioxide levels in her blood." At some point, a doctor asked them to wait outside.

"So you want to check how her heart is doing." She said.

"Yes. Can I stay?" Ellis asked, not even thinking about taking no for an answer. But she made that decision without the senior doctor was very insistent about them waiting outside so that they can do their job: making sure everything was in working order.

"We need you to wait outside. It's simply too crowded in here and a break would do all of you good. There are rooms at the end of the hallway where you can sleep and prepare small meals." The cardiologist offered after he saw that they didn't make the intention of leaving the room.

"You …" Ellis started but was cut off by her older sister: "Let's go, Ellis." She reached for her, completely ignoring her protest. "Cath, what the hell are you doing? Let me go."

But her sister pretended not to hear any of this.

"You need to get away for a while and this is the perfect opportunity." She said when they were standing in the hallway. "Yeah, they are doing tests on my baby and I don't get to see what the results are." Ellis muttered. They were now standing in the hallway, facing each other. Now Ellis and her sister were alone again.

"I still don't understand why you won't take a break from all this." She tried again. "Damn it, Catherine. I have to stay here. I can't just leave …" But Catherine cut her off before she could continue. "Meredith won't be alone. I can stay and watch her. Also, there's a herd of doctors and nurses attending to her."

"But there are still a thousand things that could go wrong." Ellis reasoned.

"I can't sleep knowing that these complications might become reality. I never thought my child would be born with a malformed heart. I never thought about that. But then it happened and now I'm here, waiting for a miracle. And of course, miracles rarely happen." They do, just not when you need them to happen so desperately …

"They do. You just have to believe it." Ellis huffed.

"This situation's making it very hard for me to believe that there can be a good ending to this." She motioned to Meredith. "That's understandable but you need to take a second to take care of yourself." Her sister answered softly. She could imagine that this was difficult but she didn't know.

"You don't understand any of it. You think you do but you don't because you've never been there. You've never been where I was. You don't know what if it feels like to see your child like this." She breathed heavily. Her sister just looked at her shocked.

She hasn't expected such an outburst coming from Ellis.

She'd always been reserved, keeping her emotions to herself.

Then she nodded before replying to Ellis' reaction.

"Okay, you're right. I don't know how this must be like for you. But I am here to offer support." Ellis scoffed. "You weren't there when she underwent her first open heart procedure. Where were you then, huh?" She asked. Catherine sighed. "I'm sorry I wasn't here when she was born." Ellis stared at her sister, hurt. She knew now wasn't really the time for this argument but she just couldn't help it. "But you promised you'd be there no matter what. And then you aren't there. I'm not saying you are like Thatcher but I really wish you had been there."

"What about Richard? I hear he's a good friend." She replied, glancing at her sister before looking at the heart monitor that is beeping continuously and steadily. There weren't any alarms going off.

"Well, I guess that's over."

"How come?"

"He has a wife." Ellis hissed. "That didn't stop you before." She muttered, hoping Ellis wouldn't hear that. "What did you say?" She exclaimed loudly. "Take that back." She said angrily. "You have no right."

She breathed in. "You have no right. You might be my sister and the only adult relative I have but you have no right."

"Well, for starters, you have a family." Her sister told her.

"They are not exactly talking to me. And I still don't know why." Ellis replied bluntly and matter-of-factly. "Why aren't they?" Catherine pressed. "You are making me deal with this now? My child is on ECMO."

"You'll keep using this as an excuse, won't you?"

Ellis stared at her, couting silently to ten before attempting to answer.

"You have no idea what that means."

"So tell me." Her sister countered.

Ellis had no idea how much time has passed since the physician sent them away. After the doctors did the necessary exams, they left her room. "Dr. Grey, we're done here. You can go back. But we do need to have a talk." The more experienced doctor said while the younger one left to check another patient.

"About what?"

"We need to talk about visiting hours." He told her.

"Why do we need to talk about visiting hours?" Ellis asked confused. "There are certain regulations that need to be respected. For the last few days, I let you but now there are restrictions." Ellis glanced at him. "You can't do this."

"I can. I need to do this." He only said.

He did not say anything about that she would need her strength for later – if there's a later – and that staying here all day and night wouldn't help change the situation. "Fine. But page me the _second_ anything changes." Ellis glared at him disapprovingly. "We will." With that he leaves. Ellis felt Catherine's glances lingering at her.

"You okay?"

"I'm _fine_." Ellis gritted out.

Catherine laughed unhappily before trying to reason with her sister.

"You're always fine. That has always been your problem. Why don't you go home and take a nice and warm shower? Eat something. I'll stay with my niece to make sure she's doing okay." She offered. She knew that Ellis needed to get out here. She wouldn't be able to keep this up. She needed to take care of herself as well.

"But don't touch the circuit." Ellis reminded her again.

"I won't touch the circuit." Her sister responded patiently. But she was rolling her eyes, knowing Ellis wouldn't see that.

"What, do you think I'm an idiot? If you tell me not to touch the circuit, I won't touch the circuit." She then added.

"Just making sure that you know this." Ellis mumbled before entered her baby's room to see her for a minute before going home. "Ellis?"

"Yes?" She said annoyed, still staring at Meredith.

"You wanted to go home. To shower, just get out of the hospital for some time..." Suddenly, Catherine was standing next to her, she put her hand on her arm. Ellis breathed in before turning around and facing her sister.

"I know." She said quietly.

She did not want to leave.

What if something happens and she is not there?


End file.
